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Author Topic: Patellofemoral surface repair  (Read 2302 times)

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Offline troydonovan

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Patellofemoral surface repair
« on: August 21, 2002, 03:10:54 AM »
Question for knee guru and anyone in-the-know. Need info on any surgeons/procedures for repairing the patellofemoral cartilage surface.

To cut a very long story short, the injury history is....
- Patella fracture (3 pieces) at age 11, 2 retained, one piece discarded. Almost full recovery to most sports.
- Knee cartilage tear at age 17, fixed with pinhole surgery. No real problem.
- Fractured the patella AGAIN at age 18. Serious pain fixing this one! Recovered with PT and pain, put up with the normal arthritis pain/aches and from cycling moved to competing in mountainbike racing for several years at expert level, pretty good recovery.
- Knee gave up at age 26, very sharp disabling pain all of a sudden (while training one day), knee had no go,  xray found worn out cartilage surface.
- Now 30, knee is getting worse by the month. Can only manage limited excersise due to the aggrivation it causes. Quad muscle atrophy is serious. Knee now has the most interesting and intense pain during movement. Cannot drive a manual car, run, climb, sit for long periods (try a 16hr flight in cattle class!!).

As you can see, the knee is in a mess. Saw a nice looking patellofemoral plate on www.coringroup.com. Can this be used to replace the damaged cartilage, and if so, who can do it. I cant find a surgeon in New Zealand who has used these devices. Dont want to ditch the patella, much as I'd love to, if there is a plate that can cover the worn spot in the cartilage.

Troy


Offline mark

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Re: Patellofemoral surface repair
« Reply #1 on: August 21, 2002, 04:43:31 AM »
sounds like your about in the same boat as I am, right now I am being considered for carticel, they regrow cartlage cells out of your knee, best that you just do a search just look up carticel, but good luck getting any feed back on this sight, very few people know much about it. good luck!!
2/95 Rt knee scope, 3/96 L knee scope, mencus repair, 1/02 L knee scope, realligned patella debrided cartlage damage, 10/02 carticel harvest attemped, failed, 12/02  L knee Fulkerson

Offline noddy

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Re: Patellofemoral surface repair
« Reply #2 on: August 21, 2002, 10:28:37 AM »
I am 2 weeks post op from having the carticel procedure on my patella. I had almost no cartilage left. The surgery is not easy. 2 and a half hours long and several days in hospital.I have just started physio and will be having 3 sessions per week plus some hydrotherapy. It is a long rehab but hopefully worth it. If you have any questions just ask. Hope this has been of some help

Offline troydonovan

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Re: Patellofemoral surface repair
« Reply #3 on: August 21, 2002, 06:13:31 PM »
Mark, Noddy.

Hey thanks for that. Just been searching carticel and found some good info. At least the picture looks better than the reports from people who had the patella completely removed. I am looking into the ACI as an option now :)

To anyone else out there, if you have info on where to look for this please post it. I will dig away and find the best Carticel sites and post these in a week or two.

Does anyone have info on the PKR of the patellofemoral surface?? This seems like a new option, but really if one looks at the TKR kits, the Patellofemoral plates are just a cut-off of the old design son I would imagine this is actually quite a proven design.

Kneeguru, any thoughts on this ????
Troy

burbn8r

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Re: Patellofemoral surface repair
« Reply #4 on: August 21, 2002, 10:59:19 PM »
Troy,

 I had a patellofemoral joint rplc almost 4 months ago. The back of the patella and the trochlear groove of the femur were resurfaced. It was considered 80% of a total. To be honest I think it would have been better is my OS did a total but because I am only 37 he wanted to try this first. Although the pain in the PF joint is gone I am now having pain on both sides of my knee. I am also having problems with my patellar tendon because of my previous surgeries. If you have any questions about the PF rplc I'd be happy to answer them if I can.

Audrey

Offline troydonovan

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AudreyRe: Patellofemoral surface repair
« Reply #5 on: August 22, 2002, 01:01:24 AM »
Audrey

Thank you for your reply. Can you tell me how the job was done. Was the back of the kneecap scraped, or a new polymer surface attached to it. Likewise was the Articular cartilage removed and replaced with an ACI treatment, a plate or a graft (forgotten the types) ?

Very interested in howeve you can help as I am looking at ways of getting back to walking pain free (comparably) while avoiding a patellectomy.

Many thanks
Troy  

burbn8r

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Re: Patellofemoral surface repair
« Reply #6 on: August 22, 2002, 03:31:42 AM »
Troy,

 With my surgery they inserted the femoral component first. I had grade 4 wear along the medial aspect of the trochlea. Since there are only 3 different sizes of parts my surgeon had to determine which one was going to fit best, then he cut away all the cartilage from that area
just into the bone.  He then drilled 3 holes into the bone to fit the metal piece.

 Next was the patellar component.  I had grade 4 wear of the entire patella. First, the thickness of the patella was measured. Normally it is cut down to half of it's original thickness, with no less than 13mm of original bone remaining. In my case my original patella was 19.5mm thick so taking it down to 13mm only removed 6.5mm of bone. The standard patellar component is 11.5 mm thick so I actually now have a patella the is 5mm thicker than the original. (which might explain the bursitis I have). 3 holes were drilled into my remaining bone to affix the prothetic patella. There is a"button" on the back of it so it to glide in and out of the trochlear groove. Once the tracking and motion were checked both components were cemented in place.

 The components used are manufactured by DePuy. They have a website at www.depuy.com but unfortunately are not shown on the site.

 Hope this answers some of your questions. Feel free to ask more.

Audrey

Offline adis55

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  • PFS due to twisting knee, hoping to avoid surgery
Re: Patellofemoral surface repair
« Reply #7 on: August 22, 2002, 09:25:25 PM »
I posted this elsewhere, but is really relavant here,

http://web.mit.edu/newsoffice/nr/2002/cartilage2.html
PFS in Rt knee for over a year.

Offline wendy

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Re: Patellofemoral surface repair
« Reply #8 on: August 23, 2002, 03:21:10 AM »
Troy,

I am in the process of waiting for my PKR to be scheduled. Unlike Audrey my prosthesis is being hand made from specs from a cscan. I am not sure why my OS opted for a specially made one other than that is the what he felt would be best.

My OS willhave on hand the rest of the pieces for a TKR if needed. At this point we are going to try this on myy left leg. If it works well then we will schedule the right one to be done also.

I do want to quote my OS again to remind us where we stand when it comes to this joint. "No one knows how to truely fix the PF joint. Right now it is a mystery." From his research what works for one may not work at all for the next.

Good lick and do all the research you need to do before you make a decision.

Wendy
began running long distances at age 7. Now I have two knees that have given in to my abuse! 3 scopes, LRs, Patella tendon repositionings, and years of pain. PKR on both. Diagnosed with RSD 3/4/2003.

Offline troydonovan

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Re: Patellofemoral surface repair
« Reply #9 on: September 11, 2002, 04:37:05 PM »
Wendy

Many thanks for the info. I am seeing my surgeon in November, who inadvertently seem to have an aversion to patella prosthetics. Also seeing a specialist in ACI technique to see if that is viable. Like you say, need to research fully.

Also posted a topic on Glucosamine & chondroitin to see what people know of these supplements. So many options, that get reduced to so few once a choice is finally made.

Thanks again
Troy